Universal shoe splint assembly

ABSTRACT

The present invention is an improvement in orthopedic devices of the type suitable for treating malformation of the lower extremities of infants and children. A multi-purpose splint or brace is provided which permits the orthopedic surgeon to make the widest possible range of corrective adjustments with or without controlled movement in pre-selected directions.

United States Patent [191 Friedman 1 Dec. 11, 1973 1 UNIVERSAL SHOE SPLINT ASSEMBLY 211 App]. No.: 222,732

[52] US. Cl 128/80 A [51] int. Cl. A611 3/00 [58] Field of Search 128/80 A, 80 C, 80 F, 128/80 B, 83, 87

{56] References Cited UNITED STATES PATENTS 2,630,801 3/1953 Mest et al. 128/80 A 2,588,411 3/1952 Robinson 128/80 A 2,906,261 9/1959 Craig 128/80 A 3,304,937 2/1967 Callender 128/80 R 2,963,020 12/1960 Moran 128/80 A OTHER PUBLICATlONS A Universal-Joint Club Foot Splint by Gibson et al.,

Journal of Bone and Joint Surgery, 1954, p. 658-659.

Modified Denis Browne Splint for Unilateral Club-- Foot by Thomson et al., Journal of Bone & Joint Surgery, 1955; p. 1286-1287.

Fillauer Detachable Night Splint Journal of Bone and Joint Surgery, 1951 page 47.

Primary Examiner-Richard A. Gaudet Assistant Examiner-J. Yasko AttorneyHyde W. Ballard [57] ABSTRACT The present invention is an improvement in orthopedic devices of the type suitable for treating malformation of the lower extremities of infants and children. A multi-purpose splint or brace is provided which permits the orthopedic surgeon to make the widest possible range of corrective adjustments with or without controlled movement in pre-selected directions.

9 Claims, 20 Drawing Figures PATENTEDDEB 1 1 m5 3.771.747

SHEEI 10$ 3 PATENTEDOEC 1 1 ms 3,777L747 sum 3 0r 3 UNIVERSAL SHOE SPLIN'I ASSEMBLY In carrying forward the improvements described in my US. Pat. No. 3,265,063, I have achieved a universal splint construction which enables the patient to be treated for any condition requiring correction of the lower limbs. The improvements described and claimed herein furthermore can be utilized with conventional footwear for the patient and thus greatly reduce expense and inconvenience. Not only does this mean that special corrective shoes are eliminated, but the shoes may be detached or disconnected from the corrective structure and worn for normal use if such is indicated for limited periods by the particular patient, or the shoes may be used by any other child without the necessity of their having to be discarded.

As described in my preyious patent referred to above, it will be noted that the splint or corrective device in various forms is intended primarily to permit limited or controlled movement of the patients feet in a pre-determined direction either linear or arcuate or possibly both. The present invention not only provides an improved splint in which limited'movement may be accomplished, but it may be locked to insure a perfectly rigid position of the patients feet in any conceivable position prescribed by the surgeon. An additional feature of the present invention is to provide an improved clamp and control means for achieving limited movement but within pre-determined parameters of the same general nature as described in my previous patent but in which the positions and the ability to provide desired adjustments are greatly enhanced.

In order to avoid the necessity for illustrating and describing the prior art, the disclosure of my US. Pat. No. 3,265,063 together with each and every reference cited during its prosecution are incorporated herein by reference. This patent will be referred to hereinafter as my '063 patent.

Referring now more particularly to the drawings,

FIG. I is a perspective of the preferred embodiment of the invention showing the means for attaching the supporting element. The attaching means is the same or similar to that described in my '063 patent except that it is located at the back of the shoe counter instead of being offset in an amount which controls the degree of external rotation,

FIG. 2 is a perspective showing the manner of securing a pair of shoes, modified as in FIG. 1, to a universal splint designed in accordance with the present invention,

FIG. 3 is a perspective of one end of the splint of FIG. 2 modified to illustrate the ability to achieve any desired degree of angular positioning of the shoe with respect to the splint body in three different planes, all of which are at 90 to each other,

FIG. 4 is an enlarged sectional detail as seen at 4-4 of FIG. 2 showing the attaching means for each of the shoes,

FIG. 5 is an enlarged sectional detail as seen at 55 of FIG. 2,

FIG. 6 is a modified splint arm which can be utilized in the structure of FIG. 2 and which is readily convertible from a limited hinged type to an absolutely rigid type, or vice versa,

FIG. 7 is a top view of the splint arm shown in FIG.

FIG. 8 is a top view of a modified form of shoe retaining plate which can be utilized with the splint structure of FIG. 2 but which requires no alteration or modification of the shoe itself.

FIG. 9 is a section seen at 9-9 of FIG. 8,

FIG. 10 is aperspective showing adjustable toe clamp structure of FIGS. 8 and 9,

FIG. 11 is a modification of the form of FIGS. 8 and FIG. 12 is a section as seen at 1212 of FIG. 11,

FIG. 13 is a fragmentary detail showing a modified shoe plate,

FIG. 14 is a fragmentary detail showing the toe clamp for the plate of FIG. 13,

FIG. 15 is a still further embodiment showing a shoe holding plate for use with my improved splint which does not require any alteration of the shoe itself,

FIG. 16 is a fragmentary sectional view as seen at 16l6 of FIG. 15,

FIG. 17 is a fragmentary sectional view as seen at l7-17 of FIG. 15,

FIG. 18 is a still further improved orthopedic shoe structure providing controlled external rotation within pre-determined limits,

FIG. 19 is a fragmentary detail of the connecting link shown in FIG. 18, and

FIG. 20 illustrates the manner in which the connecting'link of FIG. 19 can be attached at the opposite end of the shoes to provide limited internal rotation.

All of the prior art devices intended to correct the pertinent deformities in infants and children with which I am familiar have one or more serious disadvantages.

First of all, none of them is designed so that one device can be used to correct any condition. Many of them are cumbersome, expensive and have the disadvantage that there is no provision for adjustment to a predetermined position. This is important because in the event that the adjustment is loosened, it becomes necessary to reset it to the proper position. Furthermore, it eliminates the necessity for having the surgeon make every adjustment either from the standpoint of a repetitive adjustment or from the standpoint of an increase or decrease during progress of the treatment.

As will be noted, the present invention carries forwa qfihe ssi a fth d vi r heslinmy 50 patentpand in additio'nfprovides completely universal adjustment in every direction and angle for each foot individually. It also permits an accurate resetting of any given adjustment as well as the ability to vary an initial adjustment in pre-determined increments that are always constant. Any single adjustment can be varied completely independently of any other adjustment; for example, the apparatus of Israel 2,514,870 provides ad justment for abduction and adduction, internal and external rotation, but cannot be adjusted for flexion. Furthermore, there is 'no way by which a pre-determined adjustment can be accurately duplicated or altered in increments if the tightening devices are loosened.

In the drawings, a conventional childs shoe 24 is provided with an attaching element 25 which takes the form of a serrated disc of the same or similar type described in my '06} patent. In that case, however, the disc or discs were located on the shoe counter in a position to provide the desired angle of internal or external rotation. The disc 25 maybe protected by a cap 26 which prevents damage or injury in the event the shoe 24 is used normally without the corrective splints of the invention. In order to achieve the maximum angular relative rotation, it is desirable to mount the connecting element 25 at the center of the counter as shown in FIG. 1 rather than in the offset position described above. In a condition which requires correction for only abduction or adduction, either with or without internal or external rotation, I use the splint assembly 27 shown in FIG. 2. This assembly is provided with a plu rality of square apertures 28, 28 at either end. A matching pair of serrated discs 29a, 29b are secured in any desired aperture 28 by means of a bolt 30 (FIG. and a wing nut 31. The lower disc 29a in FIG. 5 is provided with a square shoulder 29c to prevent rotation thereof in the selected aperture 28. The upper disc 29b is integral with the angle member 32 so that this angle may be held in any desired rotated position with respect to the bar 270 of the splint assembly by removing the wing nut 31 from bolt 30. The angle 32 may be mounted in any one of the apertures 28 that may be desired. The opposite extremity of angle 32 is likewise provided with an integral serrated disc 33 which mates with the disc or element 25 on the shoe 24 (FIG. 4). Element 25 is secured to the counter of shoe 24 by means of the blind nut 34. Clamping shoulder screw 35 permits the serrated discs 25 and 33 to be mated at any desired angular position and firmly held in such position by tightening the shoulder screw 35 in the blind nut 34 and against washer 40.

It will be understood that the shoe attaching structure for each shoe shown in FIG. 2 is identical and the same reference numbers with primes are used for the shoe and the corresponding elements at the opposite end of the bar 27a.

As seen in FIG. 2, each shoe may be rotated about an axis through the center line of shoulder screws 35,35 in either direction to provide whatever degree of abduction or adduction the surgeon prescribes. Furthermore, each shoe may be turned around the center lines or axes of bolts 30, 30' to provide the prescribed angle of internal or external rotation for each foot independently of the other. Also, the lateral distance between the shoes 24 and 24' is capable of ready adjustment by selecting the desired two apertures 28 and 28'. What is more important, any set adjustment may be accurately duplicated because the bar 270 is provided with square apertures 28 and 28 as distinguished from a slot. With three apertures at either end of bar 27a, it is possible to achieve an accurate repeat of six or more adjustments depending, of course, upon whether the spacing between apertures is the same or different end for end. Any desired angular adjustment for external or internal rotation can also be accomplished simultaneously with any degree or abduction or adduction. The angle between the broken lines shown in FIG. 2 shows the position of the splint assembly for moderate external rotation. The shoes are set at zero adduction and abduction.

For patients who require a combination of rotation, abduction or adduction, and flexion (either dorsal or plantar), an additional angle 36' is used between the angle 32' and the connecting element 25' (FIG. 3). This additional angle 36' can be attached at either or both ends of the assembly. Angle 36 is secured to the serrated disc 33 of angle 32 through an integral disc 37' secured to the end of angle 36. As shown in FIG. 3, the opposite end of angle 36 is provided with an integral serrated disc (not shown) which mates with element 25' on shoe 24'. This connection with angle 32' is made through wing nut 38 and bolt 39. The cross section through this connection would be the same as that shown in FIG. 5. Rotation as indicated in FIG. 3 through the axis or center line of bolt 39' provides any desired degree of flexion, either dorsal or plantar.

In order to insure that the correct setting or resetting is obtained, the bar 27a as well as any of the angles 32, 32'; 36,36 may have suitable calibrations as shown clearly in FIG. 9 of my 063 patent. in this way, a simply adjustment or resetting can be made by a parent without the necessity for taking the splint assembly to the surgeon.

In cases where the surgeon desired limited movement of the patients legs or feet, the bar 27a is provided with a hinge 45 (FIGS. 6 and 7) which may be connected or disconnected as conditions require. In the event that the hinge is not needed, a rigid connection rendering the hinge inoperative is made by means of the plate 46 shown in FIG. 6 attached to each flange of the hinge by means of screws 47, 47. Since the hinge of FIG. 6 has an offset pintle 48, the movement of the hinge arms is not 360 but is somewhat more thanl80 as shown by the broken lines in FIG. 6. Where this limit of relative movement between the bar sections is desired, the surgeon can designate in which direction he desires the movement to take place. This is accomplished simply by turning the bar 180 so that the angles 32, 32 are secured on whichever side of the bar 270 pivots on pintle 48 in an amount to achieve the desired result.

Referring now to FIGS. 8-10, in situations where it is indicated that no modification of the shoe whatsoever should be made, I provide a shoe plate 50 having relatively tapered side flanges 51 and 52 with an upper lip 53 and 54 on each flange extending inwardly into which the sole of the shoe is fitted. A heel stop 55 limits the backward position of the shoe and the toe clamp 56 has an upstanding tab 57 (FIG. 10) which engages the toe of the shoe. The clamp 56 is longitudinally adjustable forany size shoe by loosening the wing nut 58 and sliding the clamp 56 to the desired position whereupon the wing nut 58 is tightened against washer 59 by turning it on the bolt 60. A serrated disc 61 is secured to the bottom of the plate 50 so that any desired rotated position of the shoe may be achieved. It is to be understood that the plate 50 of FIGS. 8 and 9 may be used in the splint assembly of FIGS. 2 and 3 either with or without the extra angle or angles 36, 36'. Obviously, either angle 36 or angle 36 can be turned downwardly 90 (FIG. 3) to receive the plate of FIG. 8.

A modified version of the plate shown in FIGS. 8 and 9 is illustrated in FIGS. 11-14 in which the plate 65 is provided with elongated flanges 66 and 67 and in which the mounting disc 68 is secured by means of rivets 69, 69 in a dimple centrally positioned in the plate 65. The heel stop 70 is formed integrally with the plate 65 and the toe clamp 71 (FIG. 14) may be positioned either in slot 72 in plate 65 or the plate may be provided with a series of perforations 73, 73 (FIG. 13) so that the toe clamp 71 may be positioned in the proper perforation to accommodate different shoe sizes.

A still further modified form of shoe clamp is shown in FIGS. 15-17 in which the plate 75 is provided with serrated disc 76 secured in the dimple 77 by means of rivets 78, 78. A pair of flanges 79 and 80 as well as the heel stop 81 are formed integrally with the plate 75. In the modification of FIG. 15, the toe clamp compises an elongated bolt 85 extending laterally across platform 75 and in slots near the forward terminii of flanges 79 and 80. The head end of. bolt 85 provided with a square shoulder at 86 which engages the slot 87 in flange 79. The opposite end of bolt 85 is provided with a square shoulder washer 88 engages the slot 89 in flange 80. The bolt 85 may be moved longitudinally to clamp the toe of the shoe securely in place by means of tightening wing nut 90.

To provide an improved and less expensive corrective shoe assembly than the one shown in my (063 patent, it is possible to secure the individual shoes to a pair of plates or sub-soles 100 and 101 as shown in FIG. 18. This attachment may be made by glueing, riveting or any other convenient means. The platforms 100 and 101 are provided with a series of peripheral apertures 102, 103 and 104 as well as corresponding apertures at the backs of the platforms through which a toggle or swivel joint 105 is secured by means of bolts 106 and 107. In this construction, the swiveling permits free flexion, but provides a minimum rotation as shown in FIG. 18 since the length of the swivel 105 does not permit the platforms to pivot closer than permitted by the position of apertures 106 and 107. Minimum internal rotation in any desired degree can be provided by removing the swivel 105 from the backs of the platforms and relocating it in the toe portions as shown in FIG. 20. The swivel 105 comprises a double shoulder rivet 110 secured in the cupped clevis ends 111, 112 of swivel 105. These cupped clevises will abut each other as shown in FIG. 19 to prevent more than limited predetermined angularity of the swivel regardless of the relative plantar or dorsal flexion of the platforms 100 and 101. This modified platform can be used independently of the splint assembly 27 or it may be used in place of any of the platforms shown in FIGS. 8, 11 and simply be securing a serrated disc to the bottom thereof. In this way, it can be utilized to provide a very inexpensive device for specific conditions or it may be quickly adapted to be used in the universal splint assembly described above.

While Brackman et al US. Pat. No. 2,482,646 describes a splint with perforations in the shoe platform, these are used for affixing a rigid splint and do not permit any freedom of movement whatsoever.

My improved splint is unique in its design because for the first time it allows the medical profession to adjust the splint for adduction and abduction according to degrees on either or both feet while'having at the same time the advantage of a flexible or rigid bar setting adjustable for distance between the feet.

It provides more comfort in varus cases to leg and foot area of the patient and eliminates pressure sores and blisters.

It allows treatment of knock-knee and bow-leg cases with proper adduction and abduction to a degree during sleeping hours, so that wedging of shoes can be minimized during the day. At the same time, the surgeon may, during the treatment, adjust the distance between the feet for a more satisfactory result in these cases. Older children who needed this treatment in the past would not accept the rigid bar. Now a surgeon may treat this condition in older children using the flexible bar.

Having thus described my invention, 1 claim:

l. A splint assembly for corrective shoes comprising an elongated bar, two right angle members mounted in spaced relation to each other at opposite ends of said bar, a plurality of non-circular apertures in said bar, inter-engaging serrated clamping means for adjusting the angle members to any pre-selected rotated position about the axis of said clamping means, a non-circular shoulder on each of said serrated clamping means for rigidly retaining one of said interengaging clamping means in two of said non-circular apertures, and interengaging serrated clamping means for adjustably securing a shoe to the end of each of said angle members whereby the relative position of said shoes with respect to each other can be securely adjusted to any preselected condition of internal rotation, external rotation, adduction or abduction.

2. A splint assembly in accordance with claim 1 in which the apertures are square.

3. A splint assembly in accordance with claim 1 in which the clamping means between the shoe and the other end of the angle includes a serrated washer nonrotatably permanently secured to the shoe and a removable cooperating serrated washer non-rotatably secured to the angle member.

4. A universal splint assembly in accordance with claim 1 having two angle members at each end, the second angle member adjustably secured at one end to the shoe and adjustably secured at the other end to the first angle member, means for rigidly clamping the shoe and the angle members together in any preselected rotational position of relative adduction, abduction, internal rotation, external rotation, plantar flexion or dorsal flexion.

5. A universal splint assembly in accordance with claim 1 in which the bar is provided with a hinge and means for selectively locking said hinge in a rigid and immovable position.

6. A splint assembly in accordance with claim 1 in which the means for attaching the angle to the shoe comprises a plate having tapered sides, a pair of flanges extending along each tapered side, a heel rest at the narrow end of the plate, and adjustable clamping means at the wide end of the plate for securing a shoe onto the plate when the shoe is fitted between the flanges.

7. A corrective shoe assembly providing limited external rotation with free dorsal and plantar flexion comprising a swivel pivotly secured at one end to the sole portion of a shoe and at the other end to the sole portion of a mating shoe, said swivel having complete free relative rotation about a longitudinal axis and a predetermined limit of angular movement from said longitudinal axis.

8. A corrective shoe assembly constructed in accordance with claim 7 in which the swivel is pivotly mounted to an extended shoe sole adjacent the heels thereof to provide minimum external rotation.

9. A shoe assembly constructed in accordance with claim 7 in which the swivel is pivotly mounted to an extended shoe sole adjacent the toe thereof to provide minimum internal rotation. 

1. A splint assembly for corrective shoes comprising an elongated bar, two right angle members mounted in spaced relation to each other at opposite ends of said bar, a plurality of noncircular apertures in said bar, inter-engaging serrated clamping means for adjusting the angle members to any pre-selected rotated position about the axis of said clamping means, a non-circular shoulder on each of said serrated clamping means for rigidly retaining one of said interengaging clamping means in two of said non-circular apertures, and inter-engaging serrated clamping means for adjustably securing a shoe to the end of each of said angle members whereby the relative position of said shoes with respect to each other can be securely adjusted to any preselected condition of internal rotation, external rotation, adduction or abduction.
 2. A splint assembly in accordance with claim 1 in which the apertures are square.
 3. A splint assembly in accordance with claim 1 in which the clamping means between the shoe and the other end of the angle includes a serrated washer non-rotatably permanently secured to the shoe and a removable cooperating serrated washer non-rotatably secured to the angle member.
 4. A universal splint assembly in accordance with claim 1 having two angle members at each end, the sEcond angle member adjustably secured at one end to the shoe and adjustably secured at the other end to the first angle member, means for rigidly clamping the shoe and the angle members together in any preselected rotational position of relative adduction, abduction, internal rotation, external rotation, plantar flexion or dorsal flexion.
 5. A universal splint assembly in accordance with claim 1 in which the bar is provided with a hinge and means for selectively locking said hinge in a rigid and immovable position.
 6. A splint assembly in accordance with claim 1 in which the means for attaching the angle to the shoe comprises a plate having tapered sides, a pair of flanges extending along each tapered side, a heel rest at the narrow end of the plate, and adjustable clamping means at the wide end of the plate for securing a shoe onto the plate when the shoe is fitted between the flanges.
 7. A corrective shoe assembly providing limited external rotation with free dorsal and plantar flexion comprising a swivel pivotly secured at one end to the sole portion of a shoe and at the other end to the sole portion of a mating shoe, said swivel having complete free relative rotation about a longitudinal axis and a predetermined limit of angular movement from said longitudinal axis.
 8. A corrective shoe assembly constructed in accordance with claim 7 in which the swivel is pivotly mounted to an extended shoe sole adjacent the heels thereof to provide minimum external rotation.
 9. A shoe assembly constructed in accordance with claim 7 in which the swivel is pivotly mounted to an extended shoe sole adjacent the toe thereof to provide minimum internal rotation. 